Physician Leadership and Social Determinants of Health (SDOH)

Physicians are accustomed to treating patients with social and environmental determinants of health (SDOH). For instance, a patient forced to choose between food or medicine due to financial instability will experience both poor health and poor quality of life. Physicians are better able to improve outcomes and lower costs when provided the resources to properly address SDOH.

A recent study conducted by The Physicians Foundation found that 80% of physicians believe that “the country cannot improve health outcomes or reduce health care costs without addressing SDOH.”(1) Physicians, supportive of addressing SDOH, are often limited in their abilities to do so. “Physicians largely feel that their hands are tied” due to external barriers, according to the report.(1)

Physicians lead the charge in addressing SDOH. They must account for the social and environmental factors when diagnosing and treating. There is ample research showing the direct link between SDOH and outcomes. Physicians require the appropriate resources to determine the best course of treatment (and how the care team will implement the plan). Physicians are, due to the hurdles, not adequately able to address SDOH, or left to their own devices (the autonomous model), to address SDOH with limited resources. Value-based care supports performance, evidence, and more equal access. Therefore, incentivizing physicians through payment models and enacting quality measures is essential.

Barriers to addressing SDOH include:

• Limited resources and tools.

• Community resources that are inadequate or inaccessible.

• Payment models and quality measures that do not account for SDOH.

• Lack of reimbursement for screening for SDOH.

Changes in policy (some in progress) will break down the barriers to addressing SDOH. Physicians identified the following steps as key to “improve health outcomes and ensure high-quality, cost-efficient care for all.”(2)

Policy steps to address SDOH include(3) :

• Provide reimbursement for efforts to address SDOH. Enact measures in a federal quality or payment program that offers incentives to physician practices and hospitals to engage their patients around these issues.

• Incentivize payers to invest in availability and quality of community resources to address patients’ SDOH.

• Provide greater flexibility for Medicare Advantage to reimburse for addressing SDOH, and integrate SDOH into payment policy (initial steps are in place regarding State Small Business Credit Initiative [SSBCI]). The effect of maintaining the status quo not only limits the ability of physicians to improve patient experience and outcomes, but takes a personal toll on physicians as well.(3)

The impact of SDOH on physicians includes(4):

• Eight in 10 physicians (83%) reported that challenges in addressing patients’ SDOH contribute to physician burnout rates.

• Six in 10 physicians (68%) believe managing patients’ SDOH has a major impact on physician mental health and well-being.

• More than half of physicians reported experiencing stress or frustration on a daily or weekly basis because of the following impediments:

1. Limited time to discuss SDOH during patient visits.

2. Insufficient workforce to guide patients to community resources to address SDOH.

3. Existing payer reporting requirements taking time away from being able to address patients’ SDOH lack of reimbursement for screening for SDOH.

References

1. The Physicians Foundation. 2022 Survey of America’s Physicians. Part One of Three: Examining How the Social Drivers of Health Affect the Nation’s Physicians and Their Patients. The Physicians Foundation;2022.

   https://physiciansfoundation.org/wp-content/uploads/2022/03/SDOH-Survey-Report.pdf

2. The Physicians Foundation. Key Findings from the Study Focus on How SDOH Affect Physicians and Their Patients. The Physicians Foundation;2022.

   https://physiciansfoundation.org/physician-an-patient-surveys/the-physicians-foundation-2022physician-survey-part-1/

3. Kornfield T et al. Medicare Advantage Plans Offering Expanded Supplemental Benefits: A Look at Availability and Enrollment. Commonwealth Fund. February 2021.

   https://doi.org/10.26099/345k-kc32

4. American Academy of Family Physicians. Addressing Social Determinants of Health in Primary Care: A Team-based Approach for Advancing Health Equity. TheEveryONEProjectTM.2018.

   https://www.aafp.org/dam/AAFP/documents/patientcare/everyoneproject/team-based-approach.pdf

Excerpted from Physician Leadership: More Valuable Than Ever — A White Paper from the American Association for Physician Leadership by Peter B. Angood, MD, FRCS(C), FACS, MCCM, FAAPL(Hon).

Download the White Paper